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Trends in Prescribed NSAID Usage

Prevalence of adults reporting usage of prescribed non-steroidal anti-inflammatory drugs (NSAID) tended to be lower after 2001–2004. The use of any NSAID was 9.5% among adults with chronic kidney disease (CKD) stages 3–5, 6.0% in those with CKD stages 1–2, and 5.9% in those without CKD during 2017–March 2020. Compared with the crude prevalence, the age-standardized prevalence of NSAID use among adults with stage 3−5 changed greatly except for the 2009–2012 surveys.

In contrast, the prevalence of NSAIDs prescriptions has increased slightly among the Clinformatics Commercially insured population. NSAIDs use was 19.6% among adults with diagnosed CKD stages 1–2, 15.0% among adults with CKD stages 3–5, and 12.6% among those with no diagnosis of CKD in 2020.

Data Source: NHANES & Clinformatics Commercial

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Percentage of U.S. Adults Using Prescribed NSAIDs by Overall and NHANES (%) National Health and Nutrition Examination Survey
NHANES	2001-2004	2005-2008	2009-2012	2013-2016	2017-2020
All Stages Combined	13.1 (95% CI: 10.8-15.5)	8.3 (95% CI: 6.2-10.3)	7.4 (95% CI: 5.1-9.7)	8.3 (95% CI: 6.7-9.9)	7.4 (95% CI: 5.5-9.2)
CKD Stages 1–2	11.1 (95% CI: 7.8-14.4)	8.1 (95% CI: 5.5-10.7)	5.6 (95% CI: 3.6-7.7)	8.0 (95% CI: 5.3-10.8)	6.0 (95% CI: 4.1-7.8)
CKD Stages 3–5	16.2 (95% CI: 13.1-19.3)	8.6 (95% CI: 6.3-10.8)	9.7 (95% CI: 5.0-14.4)	8.8 (95% CI: 6.0-11.5)	9.5 (95% CI: 6.3-12.7)
No CKD	9.4 (95% CI: 8.3-10.4)	5.4 (95% CI: 4.5-6.3)	4.6 (95% CI: 3.9-5.3)	5.4 (95% CI: 4.7-6.1)	5.9 (95% CI: 5.1-6.7)

Percentage of U.S. Adults Using Prescribed NSAIDs by Overall and NHANES (%) National Health and Nutrition Examination Survey
NHANES	2001-2004	2005-2008	2009-2012	2013-2016	2017-2020
All Stages Combined	10.6 (95% CI: 7.9-13.4)	7.6 (95% CI: 5.3-9.9)	6.3 (95% CI: 3.8-8.9)	7.6 (95% CI: 5.6-9.7)	5.4 (95% CI: 4.0-6.8)
CKD Stages 1–2	10.3 (95% CI: 7.3-13.3)	7.9 (95% CI: 5.2-10.5)	5.3 (95% CI: 3.0-7.6)	7.4 (95% CI: 4.8-10.0)	5.1 (95% CI: 3.5-6.8)
CKD Stages 3–5	9.4 (95% CI: 5.4-13.4)	5.2 (95% CI: 2.1-8.2)	10.8 (95% CI: 2.5-19.0)	12.1 (95% CI: 1.2-22.9)	5.7 (95% CI: 3.6-7.9)
No CKD	10.2 (95% CI: 9.2-11.2)	5.8 (95% CI: 4.9-6.7)	4.8 (95% CI: 4.1-5.6)	5.6 (95% CI: 4.9-6.3)	6.0 (95% CI: 5.2-6.9)

Data includes CKD stages 1–5. Estimates were standardized to the 2010 U.S. Census population for adults.

NHANES is a nationally representative, cross-sectional survey that is currently conducted every two years (since 1999) by CDC's National Center for Health Statistics among noninstitutionalized US civilian residents. The survey consists of a standardized in-home interview and a physical examination with blood and urine collected at a mobile examination center. Data were examined by combining two NHANES cycles to represent four-year periods from 2001 to 2016 and the 2017–March 2020 pre-pandemic cycle.

Note: Not all NHANES variables are collected for all years; therefore, some NHANES indicators may not utilize the full 20-year span.

Clinformatics data sets provide paid medical and prescription claims and enrollment information for participants in commercial insurance plans and Medicare Advantage plans. The sample was limited to those enrolled in their health plan for all 12 months of the calendar year. Chronic kidney disease (CKD) and diabetes are defined using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), or Tenth Revision (ICD-10-CM) diagnosis codes. Outpatient pharmacy records of prescriptions filled for patients were examined for drugs in the sodium-glucose cotransporter-2 (SGLT2) inhibitors class. For inclusion in analyses, beneficiaries had to be in the enrollment file. To define CKD, diabetes, or hypertension, at least one inpatient or two outpatient claims were used.

Field	Data
Description of Measure	NHANES: Use of prescribed NSAIDs by CKD stage in the U.S. population. Clinformatics Commercial: Percentage of patients who filled at least one prescription for an NSAID within the specified calendar year in Clinformatics Commercial population.
Data Set	National Health and Nutrition Examination Survey (NHANES). Clinformatics Commercial from Optum Clinformatics Data Mart Database (Optum Insight, Eden Prairie, MN).
Population	NHANES: Noninstitutionalized U.S. adults aged ≥ 18 years, excludes pregnant women. Clinformatics Commercial: Privately insured patients aged 20–64 years with at least one inpatient or two outpatient claims during the calendar year.
Years Included	NHANES: 2001–March 2020. Clinformatics Commercial: 2006–2020.
Numerator	NHANES: U.S. adults aged ≥ 18 years who were prescribed NSAIDs. Clinformatics Commercial: Patients aged ≥ 20 years with prescription for an NSAID identified by generic name and National Drug Code (NDC).
Denominator	NHANES: U.S. adults aged ≥ 18 years with serum creatinine and urinary albumin and creatinine measurements. Clinformatics Commercial: Patients aged ≥ 20 years enrolled in Clinformatics Commercial insurance.
Definition of CKD and CKD Stage	NHANES: CKD is defined by an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m² or albuminuria (urine albumin to creatinine ratio [UACR] ≥ 30 mg/g). Stage 1: eGFR ≥ 90 ml/min/1.73 m² and albuminuria; stage 2: eGFR 60–89 ml/min/1.73 m² and albuminuria; stage 3: eGFR 30–59 ml/min/1.73 m²; stage 4: 15–29 ml/min/1.73 m²; stage 5: eGFR < 15 ml/min/1.73 m². Estimates are based on single estimates of eGFR and UACR. Clinformatics Commercial: ICD-9-CM and ICD-10-CM diagnosis codes shown below.
Estimated Glomerular Filtration Rate (eGFR)	Based on the CKD-EPI (2021) equation for calibrated creatinine: eGFR=142 x [min(serum creatinine in mg/dL) /κ, 1)]α x [max(serum creatinine/κ, 1)]-1.20 x 0.9938age x (1.012 if female). κ = 0.7 if female and 0.9 if male α = -0.241 if female and -0.302 if male = raise to the power
ICD-10-CM Codes for CKD	Stages 1–2: N17.1, N17.2 Stages 3–5: N17.3, N17.4, N17.5 Any CKD: A18.11, A52.75, B52.0, C64.x, C68.9, D30.0x, D41.0x-D41.2x, D59.3, E08.2x, E09.2x, E10.2x, E10.65, E11.2x, E11.65, E13.2x, E74.8, I12.xx, I13.0, I13.1x, I13.2, K76.7, M10.3x, M32.14, M32.15, N01.x-N08.x, N13.1, N13.1x-N13.39, N14.x,N15.0, N15.8, N15.9, N16, , N18.1-N18.5, N18.8, N18.9, N19, N25.xx, N26.1, N26.9, O10.4xx, O12.xx, O26.83x, O90.89, Q61.02, Q61.1x-Q61.8, Q26.0-Q26.39, R94.4 (x and xx stand for all the codes within the main diagnosis).
ICD-9-CM Codes for CKD	Stages 1–2: 585.1, 585.2 Stages 3–5: 585.3, 585.4, 585.5 Any CKD: 016.0, 095.4, 189.0,189.1, 189.9, 236.91, 250.4, 250.41, 250.42, 250.43, 271.4, 274.10, 283.11, 403.xx, 404.xx, 405.01, 405.11, 440.1, 442.1, 447.3, 453.3, 573.4, 580.xx, 581.xx, 582.xx, 583.xx, 584.5, 585.x, 587.xx, 588.xx, 590.xx, 591, 592.x, 593.xx, 642.1, 646.2, 753.xx, 794.4.
Albuminuria	Urine albumin to creatinine ratio (UACR) is calculated as urine albumin divided by urine creatinine. Albuminuria is defined as UACR ≥ 30 mg/g.
Serum Creatinine	Serum creatinine values used for eGFR calculation are standardized against isotope dilution mass spectrometry (IDMS).
Urine Albumin	Measured in random urine collection by fluorescent immunoassay.
Non-steroidal anti-inflammatory drugs (NSAIDs)	NHANES: NSAIDs are defined by the medication’s generic name from the prescription medication data files. Clinformatics Commercial: NSAIDs are identified by generic name and American Hospital Formulary Service Classification System (AHFSCS) from National Drug Code (NDC): 280804xx.
Age Standardization (NHANES)	Estimates were standardized to the 2010 U.S. Census population for adults. 18–39 years: 37.1%, 40–59 years: 38.1%, 60–69 years: 12.8%, and 70+ years: 12.0%.
Limitations of Indicator	NHANES: Prevalence of self-reported NSAID use does not include over-the-counter medication use, which may not reflect overall use of NSAIDs in the adult population. Clinformatics Commercial: As a measure of prevalence, the use of ICD-9-CM or ICD-10-CM diagnosis codes without laboratory values may underestimate CKD.
Analytical Considerations	NHANES: Appropriate NHANES survey weights were used for all analyses; if relative standard error was greater than 30%, the estimates were not shown. Serum creatinine measurements were assay corrected for NHANES years 2005 and 2006 and prior to be combined with later years. Clinformatics Commercial: Consideration must be taken in comparisons of ICD code-based definitions of CKD.